iSite 3.5: Hanging Protocols I

CONFIDENTIAL 2TRN-0035-06 Rev 06/23/06

Table of Contents

• Objectives

• Terminology

• Introduction

• Hanging Protocol Hierarchy

• Presentation States

• Hanging Protocol Configuration

• Additional Information


Learning Objectives

• Hanging Protocols

• Hanging Protocol Hierarchy

• Presentation States

Understand the purpose and configuration of:


Terminology

• PACS (Picture Archive and Communications System)– Information Systems designed to manage, store and distribute

medical images and related information throughout the healthcare enterprise

• HIS (Hospital Information System)– Information Systems designed to manage patient records, including

patient registration, billing, order entry

• RIS (Radiology Information System)– Information Systems designed to manage exams (orders), including

filling orders and scheduling


Terminology

• MRN (Medical Record Number)– A unique patient identifier (also known as Patient ID) used for

auditing of billing and scheduling for patients

• Accession Number (ACCession Number)– A unique exam identifier (also known as an order number or

requisition number) used for auditing of billing and scheduling of scheduled procedures

• SUID (Study Instance Unique IDentifier)– A unique study identifier used for auditing of performed imaging

service requests


Terminology

• DICOM (Digital Imaging COmmunication in Medicine)– DICOM is the predominant communication standard between

imaging equipment throughout the Healthcare Enterprise

• HL7 (Health Level 7)– HL7 is the predominant messaging standard for exchanging key

sets of administrative and clinical data in the healthcare enterprise


Introduction


Introduction

• iSite Radiology Hanging Protocols are an important part of an efficient reading workflow

• iSite Radiology has User and System Level Hanging Protocols

• All iSite Radiology users will be able to select and utilize any User and System Level Hanging Protocols that have been created

• Hanging Protocols may be configured according to User Preferences for viewing exams on the Diagnostic Monitors based upon Modality Type, Modality Type and Body Part, and Hanging Protocol Groups


• User Hanging Protocols are created by and assigned to an individual user log-in, and are only available to the user log-in for which the Hanging Protocol was created

• In order to create, edit or delete User Hanging Protocols the user must be assigned to an Access Group that has the Security Code ISTUSRHP enabled

Introduction


• System Hanging Protocols are created by the iSite Administration team and are available to all users

• In order to create, edit or delete System Hanging Protocols the user must be assigned to an Access Group that has the Security Code ISTSYSHP enabled

Introduction


Introduction

• iSite Radiology offers the ability to create multiple Hanging Protocols for the same Exam Type

• Both User and System Hanging Protocols can be defined as Default Hanging Protocols or Alternate Hanging Protocols

• There can only be one User or System Default Hanging Protocol for each Identifier key

• There can be up to ten User or System Alternate Hanging Protocols for each Hanging Protocol Identifier key

• For example: A Radiologist who primarily reads CR EXAM exams may want to define a few alternate Hanging Protocols to switch to instead of re-hanging the entire exam


Hanging Protocol Hierarchy



• iSite Radiology Hanging Protocols may be created with varying levels of specificity based upon values associated with each individual Exam Code in the Exam Code Dictionary, including the following:

Hanging Protocol Identifier Keys Level

Modality TypeVery Generic

Modality Type + Body Part Specific

Hanging Protocol Group Very Specific



• This configuration level is specified in the Hanging Protocol Wizard


• User and System Default Hanging Protocols are identified in the popup menu as ‘default’



• User and System Alternate Hanging Protocols are never automatically applied to the Main Exam when loaded in the Canvas Page

• Alternate Hanging Protocols are not identified in the popup menu as ‘alternate’ Hanging Protocols

• However, Alternate User and System Hanging Protocols can be selected from the popup menu and are applied to an exam on the fly



• iSite Radiology applies the highest ranked Hanging Protocol available for a given exam

• The system will automatically select the most specific Hanging Protocol to load the Main Exam based on the exam Hanging Protocol Identifier Key

• If both User Default User Hanging Protocol and System Default Hanging Protocol are defined for the same Hanging Protocol identifier key, the Main Exam will be loaded with the User Default Hanging Protocol



• If only the Default System Hanging Protocol is defined for the same Hanging Protocol Identifier key, the Main Exam will be loaded with that Default System Hanging Protocol

• If no User Default Hanging Protocol or System Default Hanging Protocol is defined, the Main Exam will be loaded with the Default hard-coded Hanging Protocol




• The Main Exam is loaded in the Canvas Page with the Hanging Protocol automatically applied in the following order and hierarchy:

1. User Default ‘Hanging Protocol Group’ Hanging Protocol. This is the highest ranked Hanging Protocol. If defined for the Main Exam, this will be automatically applied. Otherwise, the System Default Hanging Protocol Group will be applied, if configured.

2. System Default ‘Hanging Protocol Group’ Hanging Protocol is automatically applied if no User Default ‘Hanging Protocol Group’ is defined for this exam.

3. User Default ‘Modality and Body Part’ Hanging Protocol. If defined for the Main Exam, this will be automatically applied. Otherwise, the System Default ‘Modality and Body Part’ Hanging Protocol will be applied, if defined.



1. System Default ‘Modality and Body Part’ Hanging Protocol is automatically applied if no User Default ‘Modality and Body Part’ Hanging Protocol is defined for this exam.

2. User Default ‘Modality’ Hanging Protocol. If defined for the Main Exam, this will be automatically applied. Otherwise, the System Default ‘Modality’ Hanging Protocol will be applied, if defined.

3. System Default ‘Modality’ Hanging Protocol is automatically applied if no User Default ‘Modality’ Hanging Protocol is defined for this exam.

4. Default Hard-Coded Hanging Protocol. If no User Default or System Default Hanging Protocols are defined, the Main Exam is loaded with a Default hard-coded Hanging Protocol.


Presentation States


Presentation States

• Presentation States over-ride Hanging Protocols

• When the user opens an exam, the Presentation State with the highest priority will be presented

• The most recent Presentation State for the highest priority Presentation State will be applied to the exam


Presentation States Hierarchy

1. “Mark Read” Presentation State is the highest priority Presentation State. If a “Mark Read” Presentation State has been defined this will automatically be applied.

2. “Pre-Read” Presentation State is the second highest priority Presentation State. The “Pre-Read” Presentation State enables a radiologist to save image presentation modifications without requiring the exam be “Mark Read”, so the radiologist may later return to the exam.

3. “Technologist” Presentation State enables the radiologic technologist to modify image presentation prior to the radiologist viewing and interpreting the exam.

4. “Original DICOM” Image Presentation is automatically applied if no Presentation States have been defined for this exam.

5. “User” Presentation State enables specialists to modify image presentation prior to and following radiologist interpretation without effecting other users.


Presentation States

• When the user selects a Presentation State any modifications based upon the following features are displayed:

– Window Width and Window Level – Measurements, excluding Point Value– Annotations– Invert Image– Key Image– Clone– Key Images– Flip– Rotate– Sort– Split


Delete Presentation State


Hanging Protocol Configuration


• Hanging Protocol configuration is specified in the Hanging Protocol Wizard found in the pop up menu in the Shelf Bar of the Exam Rack

Hanging Protocol Configuration


• The ‘Use Current Exam Layout’ option allows the ability to auto-populate the Hanging Protocol Dialog (WYSIWYG concept) when the Hanging Protocol is edited by the user

• The ‘Use Current Exam Layout’ option is only available if Series Matching Rules have been defined

Create User Hanging Protocol


• ‘Series Matching Rules’ are created and configured by the site PACS System Administrator

• To create Series Matching Rules, the user must be assigned to an Access Group with the Security Code ISTHPSTD

Create User Hanging Protocol


Hanging Protocols Configuration

• Page Two of the Hanging Protocol Wizard displays the following configuration options:

– Multi-Image Mode– Window/Level Preset– Scout Lines– Show Localizer– Invert Image– Clones


• To configure the Display settings that will be applied to all Stacked Image Windows, click on the ‘Stack Window(s)’ listing in the Series list control, then select the desired settings

• All options are available for Single Image Window(s) and Stack Window(s) with the exception of ‘Multi Image Mode’

• ‘Multi Image Mode’ options are only available for Stack Windows




• To configure the Display settings that will be applied to all Single Image Windows, click on the ‘Single Image Window(s)’ listing in the Series window, then select the desired settings

• To configure the Display settings for Clones, select each clone and make your selections


• Series Matching Rules are sub-features of Hanging Protocols

• The advantage of using Series Matching Rules as part of Hanging Protocols is:

– Automatic sorting of series

– Automatic application of features to specific series

• Multi-Image Mode• Window Width/Level

Presets• Scout Mode• Localizer Mode• Image Invert• Clones



• ‘Add Clone’ and ‘Remove Clone’ options are available for ‘Stack Window(s),’ ‘Single Window(s)’ and ‘Matching Series’ series options

• iSite Radiology provides the ability to create and configure clone settings automatically as part of a Hanging Protocol

• In the Series list control, clones can be created and removed for ‘Stack Window(s)’ and ‘Single Window(s)’

• Up to 6 clones can be created for each series option



• Multi Image Mode allows you to display stack image windows in Multi-Image modes in the diagnostic monitor

• This option is not available for single images



• Default Window/Level: Hanging Protocols support applying the default Window Width/Window Level to the Stack, Single Image Windows or Matching Series

• If the checkbox ‘Default Window/Level’ is selected, the User and System Default Window Width and Level are applied to the selected Stack, Single Image Windows or Matching Series

• Window/Level Preset: The Window Width/Level Presets allow applying quickly a specific Window Width/Level in order to view particular anatomy



• Additional presets are displayed, if configured

• Presets may be configured for all modality images

• Important Notes:

– Configured User and System Presets will be merged under Window/Level Presets list control

– If both User and System Window Width/Level Presets are configured for the same modality image and have the same Preset Name, then User Window Width/Level Presets/ Value takes precedence and User Presets will be displayed



Localizer, Scout Lines and Invert Image

• Show Localizer: This option allows the display of Localizer tool on images. When selected, images will display the localizer on all images from the same frame of reference with the image selected. Localizer is displayed only on MR, CT and PT series.

• Show Scout Lines: This option allows the automatic display of scout lines on single images or on stack series. Scout lines are displayed only on MR, CT and PT series.

• Invert Image: This feature is only available for grayscale images. When this option is selected for a Single or Stack Series, the images will be displayed in ‘Invert’ mode.


Monitor Control

• Page Three of the Hanging Protocol wizard opens with the Monitor Control group box

• In this Hanging Protocol Wizard Page, the available ‘Matching Series’ are listed in the ‘Matching Series’ list control, whereas the rack series are listed under the ‘Other Series’ list control


Matching Series

• Under ‘Series Matching’ list control, there are two buttons ‘Move Up’ and ‘Move Down’

• These are used to change the matching series order to place them on a specific monitor

• When a matching series is selected and ‘Move Up’ or ‘Move Down’ are clicked on the matching series will be moved up or down on a specific pane in Monitor 1 or Monitor 2


Monitor Control

• Monitor Mode options can be selected for Diagnostic Monitor 1 and 2:

– Monitor 1 Mode– Monitor 2 Mode

• In this window, the diagnostic monitor mode selection can be previewed for Monitor 1 and Monitor 2


Monitor Control

• Hanging Protocol Monitor 1 Mode and Monitor 2 Mode layouts are:

M1, M2H, M2V, M3H, M3V, M4, M6P, M6L, M1_2, M2_1, M1_3, M3_1

• Important Note: the monitor configuration loading differs on one-monitor systems, two-monitor systems and four-monitor systems


Main Exam Options

• Page four of the Hanging Protocol Wizard opens with the following options available only for the Main Exam configuration:

– Linking– Load Relevant Prior

based on Matching– Number of Priors to Load– Cache Entire Study– Spine Label Tool on

Sagittal– Split Mode (if enabled)


Linking Options

• The following are the available Linking options:

– Link All Axials– Link All Sagittals– Link All Coronals– Link All Obliques

• Set the Linking options as desired

• You may link all axial, sagittal, coronal or oblique views of the Main Exam


Relevant Prior Loading

• The ‘Load Relevant Prior Based on Matching’ can be configured to be loaded based on ‘Body Part Only’ or on both ‘Modality and Body Part’ matching

• The ‘Body Part Only’ option loads the relevant priors in the Relevant Exam Timeline and the Exam Rack based on matching of the same Body Part

• For example: Body Part CHEST


Relevant Prior Loading

• The ‘Modality and Body Part’ option loads the relevant priors in the Relevant Exam Timeline and the Exam Rack based on matching of the same Modality and Body Part

• For example: Modality CR and Body Part CHEST


• The ‘Number of Priors to Load’ option allows up to 10 Relevant Priors to be loaded automatically in the Hanging Protocol Wizard

• The ‘Cache Entire Study’ option allows caching of the entire Main Exam into iSite Radiology workstation memory

• If the ‘Show Spine Label Tool on Sagittal’ box is checked, the Spine Label Tool will be displayed on all Sagittal windows



Additional Information


• iSite Radiology is designed to work with one, two or four diagnostic monitor displays

• However, iSite Radiology only supports the configuration of two-monitor Hanging Protocols

• Only two monitors can be configured (i.e. Monitor 1 and Monitor 2) in the Hanging Protocol Wizard

‘F2’ Hotkey


• The hotkey ‘F2’ is designed to toggle between what is visible (i.e. Monitor 1) and what might not be visible (i.e. Monitor 2) on a two-monitor system configuration

• On a one-monitor system, the F2 key toggles between the first and second series

• Monitor 2 is considered virtual monitor on a two-monitor system

• On a four-monitor system, F2 key does not have any functionality

‘F2’ Hotkey


‘F2’ HotkeyNumber of monitors

Relevant Prior Found?

Monitor 1 Monitor 2 Monitor 3 Monitor 4

1 No

New Exam General PA

>>New Exam

General LAT

N/A N/A N/A

1 Yes

New Exam General PA

>>New Exam

General LAT

N/A N/A N/A

2 No

New Exam General PA

>>N/A

New Exam General LAT

>>N/A

N/A N/A

2 Yes

New Exam General PA

>>New Exam

General LAT

Prior Exam General PA

>>Prior Exam

General LAT

N/A N/A

4 No

New Exam General PA

>>N/A


>>N/A

Empty Empty

4 Yes

New Exam General PA

>>N/A


>>N/A

Prior Exam General PA

>>N/A

Prior Exam General LAT

>>N/A


• ‘Two-Monitor System’ loading for the Main Exam without prior will display red and blue rectangles around the first and second rack series, unless otherwise specified in the loaded Hanging Protocol

• The images will be displayed on both Monitor 1 and Monitor 2

• In this configuration, F2 key does not have any functionality

‘F2’ Hotkey


• ‘Two-Monitor System’ with prior the red rectangle will represent Monitor 1 the Main Exam will load on Monitor 1

• The blue navigation rectangle represents Monitor 2, on which the prior exam will load

• F2 key toggles between the first series displaying for the Main Exam and Prior and the second series displaying on the “virtual” Monitor 2 for the Main Exam and Prior

‘F2’ Hotkey


‘F2’ Hotkey

The image on the left represents the display prior to selecting ‘F2,’ while the image on the right displays the series following selection of the ‘F2’ hotkey


• Users can configure how the Hanging Protocol loads a Two-monitor system or a Four-monitor system in the User General Preferences ‘Main Exam Monitor Layout’ control box

Main Exam Monitor Layout


• 2-Monitor System Main Exam Monitor Layout:

– Left: Main Exam on left monitor (1), prior on right monitor (2) (this is the default selection)

– Right: Main Exam on right monitor (2), prior exam on left monitor (1)

• Four-Monitor System Main Exam Monitor Layout:

– Left: Main Exam on left monitor (1), prior on right monitor (2) (this is the default selection)

– Middle: Main Exam on inside 2 monitors (2,3), prior on outside 2 monitors (1, 4)

– Right: Main Exam on right monitors (3,4), prior on left monitors (1,2)

Main Exam Monitor Layout


• In iSite Radiology configured User and System Hanging Protocols may be imported and exported

• To accomplish this ‘Import’ and ‘Export’ buttons are provided in both User and System Hanging Protocol Pages

Import and Export Hanging Protocols


• No more than 10 User or System Hanging Protocols can be imported for the same Hanging Protocol Identifier Key

• All imported Hanging Protocols will be set as ‘Alternate’ Hanging Protocols

Import and Export Hanging Protocols


For assistance, please call customer support at

1-877-328-2808 or 1-877-328-2809

iSite 3.5: Hanging Protocols I

Documents

Transcript of iSite 3.5: Hanging Protocols I